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Step One

NOTICE: All new utility service applications require a $150 deposit for residential water service which will be billed to your account.
Lost Bin Fee*
I understand if my trash or recycling bin is missing at the end of my service needs that a $75 fee will be charged.
1. I understand
Type of Utility Service:*
1. Residential
1. Commercial
Requested Service Address*
Water Service Start Date*
Full Name/Business *
Mailing Address if different from Service Address
Apt #
City*
State*
Zip*
Phone Number*
Email Address*
Date of Birth*
Emergency Contact*
Have you ever had utility service with the City of Anna?*
1. Yes
1. No
If so, what address, when?
I have carefully read the completed Application and know the information given above is true and correct. I will comply with all City of Anna Ordinances and applicable State Laws, and accept responsibility for payment of all fees or charges. I understand that failure to do so will cause services to be discontinued which will result in additional charges to have services reinstated.*
1. I agree
Full Name*
Date
Date
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Step Two

SERVICE AGREEMENT
I PURPOSE: The City of Anna is responsible for protecting the drinking water supply from contamination or pollution, which could result from improper plumbing practices. The purpose of this Service Agreement is to notify each customer of the plumbing standards and restrictions, which are in place to provide this protection. The City enforces these restrictions to protect the public health and welfare. Each customer must sign this Agreement before the City of Anna will begin utility service. In addition, when service to an existing connection has been suspended or terminated, the City will not re-establish service unless it has received a signed copy of this Agreement.

II PLUMBING STANDARDS AND RESTRICTIONS: The following unacceptable plumbing practices are prohibited:
A. No direct connection between the public drinking water supply and a potential source of contamination is permitted. Potential sources of contamination shall be isolated from the public water system by air-gap or an appropriate backflow prevention device.
B. No cross-connection between the public drinking water supply and a private water system is permitted. These potential threats to the public drinking water supply shall be eliminated at the service connection by the installation of an air-gap or a reduced pressure-zone backflow prevention device.
C. No connection, which allows water to be returned to the public drinking water supply is permitted.
D. No pipe or pipe fitting which contains more than 80% lead may be used for the installation or repair of plumbing at any connection, which provides water for human use.
E. No solder of flux, which contains more than .02% lead can be used for the installation or repair of plumbing at any connection, which provides water for human use.

III SERVICE AGREEMENT: The following are the terms of the service agreement between the City of Anna and the utility customer:
A. The City will maintain a copy of this agreement as long as the Customer and/or the premises are connected to the Water System.
B. The Customer shall allow his property to be inspected for possible cross-connection and other unacceptable plumbing practices. These inspections shall be conducted by the City or its designated agent prior to initiating new water service when; there is a reason to believe that cross-connection or other unacceptable plumbing practices exist; or after any major changes to the private plumbing facilities. The inspection shall be conducted during the City’s normal business hours.
C. The City will notify the Customer in writing of any cross-connection or other unacceptable plumbing practices, which has been identified during the initial inspection or the periodic re-inspection.
D. The Customer shall immediately correct any unacceptable plumbing practice on his premises.
E. The Customer shall, at his expense, properly install, test, and maintain any backflow prevention device required by the City. Copies of all testing and maintenance records shall be provided to the City.

IV ENFORCEMENT: If the Customer fails to comply with the terms of the Service Agreement, the City shall, at its options, either terminate service or properly install, test, and maintain an appropriate back flow prevention device at the service connection. Any expenses associated with the enforcement of the agreement shall be billed to the customer.
Service Agreement Acknowledgement*
1. I agree
Full Name*
Date*
Date
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Step Three

CONFIDENTIALITY NOTICE
The State of Texas legislature passed HB 859 now codified in Texas Utility Code Sec. 182.052 relating to the confidentiality of certain information of the customers of a government-operated utility (such as the City of Anna). Confidential information includes a customer's name, address, phone number, social security number, and information relating to the customer's account including volume or units of utility usage or the amounts billed to or collected from the individual for utility usage. The law provides that a government-operated utility may not disclose such information contained in a customer's utility account records if the customer requests that the City keep the information confidential. The customer may request confidentiality by delivering to the City a written request to keep such information contained in the utility account confidential. Otherwise, a customer's personal information will NOT be considered confidential.

However, even though the customer may request their personal information remain confidential, the statute does NOT prohibit a government-operated utility from disclosing personal information in a customer's account records to:
(1) an official or employee of the state, a political subdivision of the state, or the federal government acting in an official capacity;
(2) an employee of a utility acting in connection with the employee's duties;
(3) a consumer reporting agency;
(4) a contractor or subcontractor approved by and providing services to the utility or to the state, a political subdivision of the state, the federal government, or an agency of the state or federal government;
(5) a person for whom the customer has contractually waived confidentiality for personal information; OR
(6) another entity that provides water, wastewater, sewer, gas, garbage, electricity, or drainage service for compensation.

If you hold an account as an individual, you have a right to request confidentiality of personal information contained in your utility account, such as name, address, telephone number, social security number, and information relating to the customer's account including volume or units of utility usage or the amounts billed to or collected from the individual for utility usage. If you do not specify your intent to keep your personal information confidential, this information will be subject to the open records provisions.
Please indicate your preference below:
1. I DESIRE for personal information on my utility account to be confidential, unless specifically exempted by state statute.
2. I DO NOT desire for personal information on my utility account to be confidential, thus causing this information to be subject to the open records provisions.
Full Name*
*This request may be rescinded only upon written permission of the utility customer whose signature appears above.
Date*
Date

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1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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